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Test Form

48 Hour Opt Out Agreement

In this agreement the following definitions apply:

Employment Business means Knockdene HealthCare.

Working Week means an average of 48 hours in each seven day period calculated over a 17 week reference period.

Temporary Agency Worker means (your name).

Restriction means The Working Time Regulations 1998 provide that the Temporary Worker shall not work in excess of the working week unless she/he agrees in writing that this limit should not apply.

Consent means the Temporary Agency Worker hereby agrees that the working week limit shall not apply.

Withdrawal of Consent The Temporary Agency Worker shall end this agreement by giving 8 weeks’ notice in writing, however, any notice bringing this agreement to an end shall not be constructed as notice of termination, by the Temporary Agency Worker. Upon expiry of the 8 week notice period, the working week limit shall apply with immediate effect.

This Agreement is governed by the law of Northern Ireland.


Knockdene HealthCare is committed to equality of opportunity for all applicants, including those with criminal convictions. Whilst the disclosure of information does not automatically debar an individual from employment, it is essential that all convictions are disclosed to allow us to adequately consider their relevance to the post in question. Knockdene HealthCare’s policy on the recruitment of ex-offenders is available on request. Knockdene HealthCare adhere to access NI’s code of practice regarding the landing-stage and disposal of disclosure information. A copy of our policy can be obtained upon request from our office on 02825442510.

Owing to the nature of the work for which you are applying, we are required to carry out a criminal records check. Access NI are the checking body, and their code of practice is available at: This post is exempt from provisions of section 4.2 of the Rehabilitation of Offenders Act 1974 (Exemption Order 1957), and as such any criminal conviction may never be regarded as ‘spent’ and must be disclosed. Failure to disclose such convictions could result in dismissal or disciplinary action.

Any conviction, caution, reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for.

Have you supplied additional information with this application for any:

Photograph Upload

Please upload a recent passport photograph:

Please note, file size must be less than 1mb and in .jpg, .png or .pdf formats.


I confirm that the information I have provided in support of this application is complete and true and understand that knowingly to make a false statement could be a criminal offence.

I consent to Knockdene HealthCare checking details I have provided in support of this application against the various data sources in order to verify my identity and process the application. These details may be recorded and used to assist other organisations, such as Access NI, NMC, Safeguarding Team, NISCC, etc.

I the undersigned, certify that the information I have provided in this application is completely true and I accept I could be prosecuted by Knockdene HealthCare Ltd. if I cause them loss, damage or embarrassment as a result of being dishonest in my dealings with them. I consent to my personal data being included on a database and to its use in order to secure me employment. I consent to my C.V. being forwarded to clients via electronic mail.